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Opioid Addiction, Tolerance, and Dependency

Tolerance to an opioid analgesic means that a larger dose of the drug is needed to achieve the original pain relieving effect. Physical dependence occurs when a patient who has been taking opioids on a long term basis experiences withdrawal symptoms when the drug is abruptly stopped or when the patient is given an opioid antagonist. Patients should not be diagnosed as addicted based only on the presence of opioid dependence. Dependence is a universal physiological and pharmacological phenomenon that occurs following the regular use of opioids for more than two weeks. Opioid dependence is no different than dependence that occurs after the administration of steroids, beta blockers, and other antihypertensives for an extended period of time. As a result, opioid dependence is not evidence of opioid addiction. Opioid addiction refers to psychological dependence on a specific drug. Addiction is characterized by a pattern of compulsive drug use, including continued craving for the opioid drug and the need to use the drug for effects other than pain relief. Addiction involves behaviors that include impaired control over drug use, compulsive use, continued use despite harm, and craving for the drug.

Tolerance and physical dependence do occur in many patients after one to four weeks of regular use of opioid drugs. Under appropriate medical supervision, opioid use alone is the not the major factor in the development of addiction. Other biochemical, social, and psychological factors appear to play an important role in the development of addiction; addiction is a disease with genetic, psychosocial, and environmental factors that influence its development and manifestations.

Extensive research indicates that less than 1% of patients who use opioids under medical supervision for pain relief become addicted. There is evidence to suggest that nurses significantly overestimate addiction potential, and that this belief influences their attitudes about giving patients opioids. One important study found that almost half the nurses surveyed believed that 5% or more of patients who receive opioids for pain on a short-term basis become addicted. The study also found that over three quarters of the nurses believed that over 25% of patients who used opioids for three to six months would become addicted. It is important that nurses are educated about what research shows about opioids and addiction. The percentage of the population with chronic pain that lasts six months and more is increasing. In addition, the population is aging and patients with malignant pain due to cancer are living longer. Nurses’ fear of addiction may contribute significantly to the under treatment of pain and poor quality of life among these patients.

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Patients who exhibit tolerance to an opioid analgesic are likely to become addicted.